"Winged sponges": houseflies as carriers of typhoid fever in 19th- and early 20th-century military camps

Typhoid fever was the scourge of 19th- and early 20th-century armies. During the Spanish-American War (1898) and the Anglo-Boer War (1899- 1902), typhoid killed more soldiers than enemy bullets. Walter Reed and his coworkers investigated the cause of the typhoid epidemics in the U.S. Army camps and concluded that, next to human contact, the housefly (Musca domestica) was the most active agent in the spread of the disease. British medical officers in South Africa, facing even worse typhoid epidemics, reached the same conclusion. The experiences of the American and British armies finally convinced the medical profession and public health authorities that these insects conveyed typhoid. The housefly was now seen as a health menace. Military and civilian sanitarians waged fly-eradication campaigns that prevented the housefly's access to breeding places (especially human excrement), and that protected food and drink from contamination. Currently, M. domestica is recognized as the mechanical vector of a wide variety of viral, bacterial, and protozoal pathogens. Fly control is still an important public health measure in the 21st century, especially in developing countries.     

The role of physicians as medical review officers in workplace drug testing programs. In pursuit of the last nanogram.

In discussing the role of physicians in workplace drug testing programs, I focus on the recent Department of Transportation regulations that require drug testing in such regulated industries as interstate trucking, air transportation, mass transit, and the railroads. These regulations require that applicable drug testing programs employ physicians as medical review officers to evaluate positive tests that have been screened and confirmed by different techniques to determine if there is a legal medical explanation for the result. The drug testing program tests for the presence of amphetamine, cocaine, tetrahydrocannabinol, opiates, and phencyclidine. If an employee testing positive has an acceptable medical explanation, the result is to be reported as negative. Little practical advice exists for medical review officers, and they must be aware of key elements of the regulations and potential trouble spots.     

Establishment of a General Medicine Residency Training Program in Rural West Africa

Ghana, a developing country in West Africa, has major medical burdens in taking care of a large population with limited resources. Its three medical schools produce more than 200 graduates per year, but most emigrate to developed lands after training. Ghana is working to educate and retain locally trained physicians, but it is difficult to get them to work in rural settings where the need is greatest. This article details the establishment of a General Medicine residency at a 150-bed hospital in rural Ghana. Early training comprises 6 months each in Medicine, Surgery, OB/GYN, and Pediatrics; the hospital in Techiman also has a Surgery residency. House officers choose the program for more hands-on experience than they can get in larger centers. They perform many tasks, including surgery, sooner and more independently than do residents in developed countries. The training program includes a morning report, clinical teaching rounds, and rotations on in-patient wards and in the Emergency Department and clinics. Teaching focuses on history, physical examination, good communication, and proper follow-up, with rigorous training in the OR and some clinical research projects pertinent to Ghana. Trainees work hard and learn from one another, from a dedicated faculty, and by evaluating and treating very sick patients. Ghana’s rural residencies offer rigorous and attractive training, but it is too soon to tell whether this will help stem the “brain drain” of young physicians out of West Africa.     

Crucible of fire: the Boer War and the birth of the Canadian Army Medical Corps.

Although Canada''s military physicians didn''t come to prominence until WW I and WW II, the Canadian Army Medical Corps (CAMC), the forerunner of the Royal Canadian Army Medical Corps and the current Canadian Forces Medical Service, actually had its origins in the Boer War. During that turn-of-the-century conflict, field hospitals accompanied Canadian troops to South Africa. Ian McCulloch discusses that early type of medical service and the steps that led to the creation of the CAMC.     

A ROLE FOR THE PHYSICIAN IN CIVIL DEFENSE

Recognition of the possibility of nuclear attack upon the U. S. imposes on the American physician the obligation of preparing to deal with its consequences. The responsibility has been accepted but every physician must continue his effort to increase our medical capabilities.Organization and planning at all levels must continue and it is most essential that physicians participate in the education of the public. The A.M.A. through its Committee on Disaster Medical Care has played an active role in the development of civilian training courses and medical planning for disaster in this country.     

Preregistration house officers in the four Thames regions: II. Comparison of education and workload in teaching and non-teaching hospitals.

OBJECTIVE--To detect differences in the education and workload of preregistration house officers working in teaching and non-teaching hospitals. DESIGN--A postal questionnaire. SETTING--Teaching and non-teaching hospitals in the four Thames regions. PARTICIPANTS--1064 Preregistration house officers. RESULTS--Response rate was 61% for teaching hospitals and 73% for non-teaching hospitals. House officers in teaching hospitals had significantly fewer inpatients under their care (house physicians 16.9 v 22.9, house surgeons 17.9 v 20.3) and admitted fewer emergency patients per week (house physicians 7.7 v 12.7, house surgeons 6.5 v 9.8). More house officers in teaching hospitals reported that they had too few patients to provide adequate clinical experience. More of their time was consumed by administrative activities devoid of educational value. CONCLUSION--Preregistration house officer posts at teaching hospitals provide less clinical activity and are perceived as less educationally satisfactory by their holders than those elsewhere.     

Where have all the giants gone? Reconciling medical education and the traditions of patient care with limitations on resident work hours

The Accreditation Council for Graduate Medical Education recently approved regulations that would prohibit residents from working more than 80 hours per week and more than 24 hours at a stretch. These regulations are scheduled to take effect in all U.S. teaching hospitals on 1 July 2003. Those who approve of the proposed regulations argue that house staff fatigue is responsible for physician error, depression, anger, and a lack of compassion for patients. But critics point to the adverse effects on key goals of house staff training--the development of accountability and responsibility. Can the rigorous discipline of medical education and the long tradition of medicine as a profession be reconciled with the current calls for limiting resident duty hours and on-call schedules? The intensity of patient care in teaching hospitals today is far greater than it was in the past. These changes in medical care make it critical to develop new programs that will reconcile rigorous, scientifically based humanistic medicine with the needs of patients and physicians. This will require imaginative and creative solutions that take a larger view of medical education and medical care than mere manpower calculations and numerical solutions focused simply on compliance with an 80-hour work week.     

REPORT FROM OTTAWA

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada''s 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada''s 6396 dentists could supply 30% reinforcement. The dentist''s training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

加强军队医院非现役编制医务人员卫生勤务保障能力的重要性

目的:调查军队医院非现役编制医务人员的军事素质和卫勤保障意识,探讨提升该群体卫勤保障能力的重要性和必要性,为军队医院卫勤管理提供参考。方法:采用问卷调查的方式对我院154名非现役编制医务人员进行调查,主要包括军事理论、卫生勤务、突发事件应急管理及战伤急救等,分析非现役编制医务人员缺乏的基本军事素质,并提出针对性的加强军队医院文职人员卫生勤务保障能力的可行性培训计划,在培训结束时对医护人员的军事素质进行测评。结果:问卷调查结果:非现役文职人员的军事素质评分为(3.70±0.46)、卫生勤务能力评分为(2.48±0.91)、突发事件应急管理评分为(2.61±0.53)、战伤急救技能评分为(2.42±1.02)。测评结果:军事理论知识评分为(4.11±1.04)、卫生勤务能力评分为(4.78±1.37)、突发事件应急意识评分为(4.56±0.56)、战伤急救技能评分为(4.68±0.91)。培训后,非现役医务人员的卫勤保障能力显著提高,差异具有统计学意义(P0.05)。结论:非现役文职作为军队医院的聘用制人员已成为医务工作的主要力量,因此军队医院应加强非现役医务人员的卫生勤务保障能力,提高我军后勤医疗保障的坚固力量。     

Antimicrobial drug use in three Canadian general hospitals.

Total amounts of antimicrobial drugs used to treat inpatients during 1975 were calculated for three Canadian general hospitals, one of them the principal teaching hospital of a medical school. Use of drugs was compared with that reported for Boston City Hospital during periods when antimicrobial therapy was and was not supervised by infectious disease consultants. Ampicillin, tetracyclines, cephalosporins, erythromycin and aminoglycosides for prophylactic oral administration were used excessively in the three hospitals. The degree of overuse was comparable to that at Boston City Hospital during years when drug use was uncontrolled. Overuse or improper choice of antimicrobial drug decreases the quality of patient care and increases its cost. More rigorous education is needed for both medical students and practising physicians in the rational use of antimicrobial drugs. Informal consultation with an infectious disease unit should be required before certain overly popular or toxic antibiotics are administered to hospitalized patients.     

Aerobic fitness and body fat of young British males entering the army.

Aerobic fitness and percent body fat were measured in a sample of 438 male Army recruits between the ages of 17 and 30 prior to the commencement of training. The sample came from all areas of England and Wales. Aerobic fitness, as represented by maximal oxygen uptake (VO2 max), was predicted from the Astrand submaximal bicycle heart rate test. Body fat was predicted from four skinfold measurements. Total group means +/- SD were: age, 19.5 +/- 2.5 years; VO2 max 41.7 +/- 8.3 ml/kg . min; and body fat, 14.5 +/- 4.8% of body weight. VO2 max varied with age, athletic participation and aptitude score. No relationship was found with occupation of parent, prior civilian occupation or smoking severity. When adjusted for methodological differences, VO2 max was slightly below similar Army entrants in Norway and the United States.     

The truth behind the legend: European doctors in pre-colonial India

The aim of this article is to point out that the medical history of India in the seventeenth century needs to be studied for its bearing on the history of medical science in this country. During the period 1644–1717, European physicians in India were sought and pampered by the Indian ruling class. English doctors were able to translate this professional goodwill into concrete commercial concessions for the British East India Company. The concessions gave the Company an edge over its rivals, and, more importantly, gave it a cause to fight for. In consequence, the Company was transformed from avaishya (trading) organization into akshatriya (territorial) one. These conclusions warrant a more rigorous professional study of European doctors vis-à-vis their Indian counterparts in the pre-colonial period.     

Hématome pharyngolaryngé asphyxiant durant l'anticoagulothérapie.

Canada has a good National Medical Stockpile valued at 21 million dollars and consisting of packaged emergency medical units ready for use in peacetime or wartime disaster. These units are available for release to provinces for pre-positioning in selected communities provided that certain storage conditions are met and that physicians and other key health workers are prepared to take operational charge of the equipment. The major packaged units are the Emergency Hospital with a capacity of 200 beds, the Advanced Treatment Centre with equipment to give emergency medical care to 500 casualties, the Casualty Collecting Unit with equipment to give first-aid care to 500 casualties, the Emergency Blood Depot, the Emergency Clinic and the Emergency Public Health Laboratory. In addition, training equipment, supplies and units are provided.The value of the stockpile has already been demonstrated in disasters occurring inside and outside Canada. Ten Emergency Hospitals have been shipped to South Vietnam for civilian use. A similar Emergency Hospital was flown to Yellowknife, N.W.T., within 24 hours of the destruction, by fire, of the Stanton Yellowknife Hospital in May 1966.     

How house officers cope with their mistakes.

We examined how house officers coped with serious medical mistakes to gain insight into how medical educators should handle these situations. An anonymous questionnaire was mailed to 254 house officers in internal medicine asking them to describe their most important mistake and their response to it; 45% (N = 114) reported a mistake and completed the questionnaire. House officers experienced considerable emotional distress in response to their mistakes and used a variety of strategies to cope. In multivariate analysis, those who coped by accepting responsibility were more likely to make constructive changes in practice, but to experience more emotional distress. House officers who coped by escape-avoidance were more likely to report defensive changes in practice. For house officers who have made a mistake, we suggest that medical educators provide specific advice about preventing a recurrence of the mistake, provide emotional support, and help them understand that distress is an expected concomitant of learning from the experience.     

Massacre over civilians during the war in Croatia

The 1991-1995 War for independence of Croatia was a cruel armed conflict, provoked by the conquering aspirations of the "Yugoslav Federal Army" under Serbian command and Serbian terrorists. It took place on the territory of the Republic of Croatia and gave rise to a mass destruction of civilian and sacral buildings and civilian massacres. Here we present three representative cases as an example of the massacre over civilians that happened in the vicinity of Vrhovine, in northwestern Croatia. Seven civilians were taken from their homes in the village of Dabar, exposed to unprecedented, savage torture and cruel execution. Forensic medicine experts revealed that victims were beaten with blunt objects, probably the butt end of rifles or high boots, stabbed with sharp objects as they were dying, and finally killed by gunshots. Their dead bodies were mutilated by cutting auricles and exposed to post-mortem humiliation. Events at Vrhovine have all the characteristics of crimes against humanity and inapprehensible breaches of the Geneva Convention at the very end of 20th century.     

Nuclear Energy in the Service of Biomedicine: The U.S. Atomic Energy Commission’s Radioisotope Program, 1946–1950

The widespread adoption of radioisotopes as tools in biomedical research and therapy became one of the major consequences of the “physicists’ war” for postwar life science. Scientists in the Manhattan Project, as part of their efforts to advocate for civilian uses of atomic energy after the war, proposed using infrastructure from the wartime bomb project to develop a government-run radioisotope distribution program. After the Atomic Energy Bill was passed and before the Atomic Energy Commission (AEC) was formally established, the Manhattan Project began shipping isotopes from Oak Ridge. Scientists and physicians put these reactor-produced isotopes to many of the same uses that had been pioneered with cyclotron-generated radioisotopes in the 1930s and early 1940s. The majority of early AEC shipments were radioiodine and radiophosphorus, employed to evaluate thyroid function, diagnose medical disorders, and irradiate tumors. Both researchers and politicians lauded radioisotopes publicly for their potential in curing diseases, particularly cancer. However, isotopes proved less successful than anticipated in treating cancer and more successful in medical diagnostics. On the research side, reactor-generated radioisotopes equipped biologists with new tools to trace molecular transformations from metabolic pathways to ecosystems. The U.S. government’s production and promotion of isotopes stimulated their consumption by scientists and physicians (both domestic and abroad), such that in the postwar period isotopes became routine elements of laboratory and clinical use. In the early postwar years, radioisotopes signified the government’s commitment to harness the␣atom for peace, particularly through contributions to biology, medicine, and agriculture.     

Hours,volume, and type of work of preregistration house officers.

OBJECTIVE--To determine the hours, volume, and type of work undertaken by preregistration house officers. DESIGN--Continuous observation of 472 hours of work performed by 12 preregistration house officers based in medical wards, using standard procedures for studying work patterns. SETTING--A teaching hospital with 340 beds assigned to general medicine and coronary care. SUBJECTS--12 Of the 16 preregistration house officers in medicine at the hospital. MAIN OUTCOME MEASURES--The hours, volume, and type of work undertaken by preregistration house officers in February 1989, as recorded by trained observers on a one to one basis. RESULTS--The hours of duty ranged from 83 to 101 hours each week, the longest period of continuous duty being 58 hours. Each shift, house officers spent up to 25 minutes travelling between wards and an average of 85 minutes treating patients in wards that were cross covered. Between 50% and 71% of house officers'' time was spent on patient oriented duties during the day; this fell to between 21% and 53% at night. Each doctor spent an average of 40 minutes filing when off duty after 6 pm. CONCLUSIONS--Established procedures for studying workload were effective in monitoring doctors'' hours, providing accurate information on the volume and type of work, which is essential to resolve the problems of medical staffing. The study showed that more house officers were needed and that the cross cover system should be stopped. As a result three extra preregistration house officers were appointed.     

Subspecialty consultations in a teaching hospital.

A chart review of 60 consultations by the nephrology service of a teaching hospital was carried out to determine their diagnostic and therapeutic utility. General medicine residents on elective rotations in nephrology performed 72% of the consultations, only 26% being written by residents in the subspecialty. Consultants made an average of 2.2 diagnoses per patient, of which 57% confirmed the working diagnosis already in the medical record. They made an average of 3.0 recommendations for further investigation per patient, but referring physicians implemented only 58% of these. An average of 1.6 recommendations for therapy were made per patient, of which 64% were implemented. The apparent neglect of the consultant''s advice for investigation and therapy suggests that the written consultation to some extent fails to convey information useful for the referring physician and the patient. Further study is needed to determine if this failure reflects inadequate training of house officers as consultants.     

A nested case-control study of leukemia mortality and ionizing radiation at the Portsmouth Naval Shipyard

A nested case-control study using conditional logistic regression was conducted to evaluate the exposure-response relationship between external ionizing radiation exposure and leukemia mortality among civilian workers at the Portsmouth Naval Shipyard (PNS), Kittery, Maine. The PNS civilian workers received occupational radiation exposure while performing construction, overhaul, repair and refueling activities on nuclear-powered submarines. The study age-matched 115 leukemia deaths with 460 controls selected from a cohort of 37,853 civilian workers employed at PNS between 1952 and 1992. In addition to radiation doses received in the workplace, a secondary analysis incorporating doses from work-related medical X rays and other occupational radiation exposures was conducted. A significant positive association was found between leukemia mortality and external radiation exposure, adjusting for gender, radiation worker status, and solvent exposure duration (OR = 1.08 at 10 mSv of exposure; 95% CI = 1.01, 1.16). Solvent exposure (including benzene and carbon tetrachloride) was also significantly associated with leukemia mortality adjusting for radiation dose, radiation worker status, and gender. Incorporating doses from work-related medical X rays did not change the estimated leukemia risk per unit of dose.